Foundation Letter of Intent

I. This pledge is intended to provide TOTAL GIFT of the amount below to the American Society for Gastrointestinal Endoscopy Foundation in support of the Beyond our Walls: The Future of Endoscopic Education and Practice campaign.

Pledge Payment Plan

Option 1: One Time Payment

Option 2: Multi-Year Pledge

This pledge commitment will be paid according to the following schedule (check one):

Annually

Semi-Annually

Quarterly

Please complete payment schedule chart to ensure reminder notices are sent on time.

2018 1st Qtr

2018 2nd Qtr

2018 3rd Qtr

2018 4th Qtr

2019 1st Qtr

2019 2nd Qtr

2019 3rd Qtr

2019 4th Qtr

2020 1st Qtr

2020 2nd Qtr

2020 3rd Qtr

2020 4th Qtr

2021 1st Qtr

2022 1st Qtr

2021 2nd Qtr

2022 2nd Qtr

2021 3rd Qtr

2022 3rd Qtr

2021 4th Qtr

2022 4th Qtr

Please indicate how you would like your gift to be allocated

Unrestricted

Education

Practice Improvement

Please indicate how you would prefer your name to be listed for donor recognition purposes: